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Information about integrated care for patients with atrial fibrillation (AF) in low- and middle-income countries is scarce. We analyzed multicentre data from 699 patients with AF treated in S&#xe3;o Paulo, Brazil. ABC compliance was defined as (1) adequate anticoagulation ('A' component); (2) controlled AF symptoms ('B' component); and (3) comorbidities treatment ('C' component). We built logistic regression models to identify characteristics associated with ABC compliance. Mean age was 69.4&#x2009;&#xb1;&#x2009;14.4&#x2009;years (45.8% women; 57.4% from private healthcare). Compliance with ABC pathway, and with the 'A,' 'B' and 'C' components occurred in 20.9%, 42.3%, 81.7% and 50.1% of the participants, respectively. Lack of ABC compliance was associated with female sex (adjusted odds ratio [aOR]: 1.66; p&#x2009;=&#x2009;0.015), intermediate (aOR: 3.37; p&#x2009;<&#x2009;0.001) and high (aOR: 9.17; p&#x2009;<&#x2009;0.001) bleeding risk. Patients with AF treated in public units had worse performance for the 'A' component (aOR: 2.50; p&#x2009;<&#x2009;0.001) and better performance for the 'C' component (aOR: 0.49; p&#x2009;<&#x2009;0.001) compared to those using private healthcare. Compliance with the ABC pathway in S&#xe3;o Paulo, Brazil was low. Lack of ABC compliance was more common in women and individuals with high bleeding risk. We found a mixed pattern of ABC compliance in public and private units.

Objective This study aimed to determine the short-term effects of a research methodology course (intervention) on knowledge enhancement of participants from economically emerging (cohort 1) and economically developed (cohort 2) countries; and to determine the long-term publication trajectory of course participants from the time of intervention (timepoint 1 (T1)) to 10 years post-course (timepoint 2 (T2)). Participants/setting Residents/fellows/junior staff from academic institutions of cohorts 1 and 2 completed a four-day research course divided into research design (M1) and statistics (M2) modules. Intervention A 30-item multiple-choice pre-test was provided at the beginning and end of the course for M1 and M2. Pre-/post-test scores assessed knowledge enhancement. A PubMed search (1966-2024) was conducted to evaluate the number, impact factor (IF), and authorship of publications until T1 and T2. Results&#xa0; In cohort 1, 21 (100%) participants (male-to-female ratio: 11:10; six residents and 15 fellows/junior staff) aspired to an academic career; in cohort 2 (male-to-female ratio: 12:7), 12/19 (63%) (seven residents and five fellows/junior staff) did. At T1, differences were noted between pre- and post-test scores for cohort 1 in M1 (p=0.0005) and M2 (p=0.001), but only for M2 (p=0.01) for cohort 2. For aspiring academicians, whereas the mean number of publications/person was similar between cohort 1 (N=1.1) and cohort 2 (N=2.75) at T1 (p=0.12), it was higher for cohort 2 (N=27.4 vs. N=8.95) at T2 (p=0.03), with similar mean IF of publications for cohorts 1 and 2 at T1 and T2 (p>0.05). Conclusion In the short term, radiology trainees from both countries benefited from the educational research program, particularly in statistics. Over a decade, whereas the quality (IF) of publications remained stable for academicians of both countries, the publication output/person remained stable for cohort 2 participants but declined for cohort 1 participants.

Pelvic exenteration is a highly complex and aggressive surgical procedure that seeks to cure patients with pelvic tumours through the en bloc removal of two or more organs. Given its technical complexity and high rates of morbidity and mortality, careful selection of surgical candidates is essential, prioritising those for whom complete tumour resection is feasible. The preoperative management of these patients requires a multidisciplinary approach, with the radiologist playing a critical role. It is imperative for the radiologist to be familiar with the anatomical and pathological aspects to be assessed using different imaging techniques (CT, MRI, or PET-CT). Key considerations include the detection of extrapelvic metastatic disease, involvement of pelvic organs, neural structures, vessels, and the pelvic wall (muscular and bony components). The aim of this update is to familiarise the radiologist with pelvic exenteration, as a thorough evaluation can provide necessary information to guide the surgical team, minimise complications and avoid unnecessary interventions.

To report the first clinical application of robotic telesurgery within the Brazilian Unified Health System (SUS) infrastructure, evaluating feasibility, safety, and stakeholder perceptions in a consecutive case series. Five consecutive robotic telesurgeries across four surgical specialties were performed using the Toumai/MicroPort platform. The remote surgeon operated from the console at PROMIN-FMUSP, while the robotic unit and patient were located at HU-USP, approximately 5 km away. All procedures used a wired network connection. A structured safety protocol with predefined conversion triggers and a standby bedside surgeon was applied. Outcomes included procedural completion, network latency, intraoperative events, and 30-day postoperative outcomes. Post-procedure structured interviews captured perceptions from the remote surgeon, bedside surgeon, and anesthesia team using Likert scales and the NASA-TLX adapted instrument. Four of five procedures were completed entirely via remote console. One case (radical prostatectomy) required conversion to local surgeon control due to a local cable disconnection at the patient site near the end of the procedure (the network connection itself was preserved); the bedside surgeon completed the remaining approximately 10 min without adverse consequences. Surgical specialties included thoracic surgery (two cases), urology, head and neck surgery, and gynecology. Median operative time was 165 min (range 106&#x2012;240). Console-reported latency was approximately 12 ms in each case. No intraoperative adverse events occurred. All remote surgeons rated perceived safety at the maximum score. Bedside surgeons and anesthesiologists uniformly considered the model safe, although saturation of most perception scores at the maximum value limited inter-case discrimination. One patient (Case 2, head and neck) had a Clavien-Dindo grade II complication (edema and pain requiring one additional day of hospitalization). No readmissions, reoperations, or mortality occurred within 30 days. The first clinical application of robotic telesurgery within SUS proved technically feasible across four surgical specialties in five consecutive low-to-medium complexity cases, with no major adverse events at 30-days. The single conversion was managed safely by the standby bedside surgeon, consistent with the intended behavior of the structured safety protocol. These initial findings &#x2012; limited by the small sample and absence of a control group &#x2012; support the continued, progressive evaluation of telesurgery within Brazil's public health system.

In the early time window, direct mechanical thrombectomy (MT) is not non-inferior to combined treatment with intravenous thrombolysis (IVT) for patients with large vessel occlusion (LVO) stroke, while its non-inferiority in the extended time window remains uncertain. This study assessed whether direct MT is non-inferior to IVT&#x2009;+&#x2009;MT beyond 4.5&#x2009;h or at wake-up. We emulated a non-inferiority trial, comparing direct MT vs. IVT&#x2009;+&#x2009;MT, including patients with anterior circulation LVO between 4.5 and 24&#x2009;h from symptom onset or at wake-up, without contraindications to IVT and with target perfusion mismatch. We used inverse probability weighting (IPW) adjusted for pre-specified covariates. The primary outcome was 90-day mRS 0-2, with non-inferiority defined by a lower 95% CI boundary of the Risk Difference (RD)&#x2009;&#x2265;&#x2009;-1.3%. Among 347 patients, 212 received direct MT and 135 received IVT&#x2009;+&#x2009;MT. After IPW, patients treated with direct MT and IVT&#x2009;+&#x2009;MT had a similar likelihood of achieving a 90-day mRS of 0-2 (adjRD -2.90 [95% CI -6.64 to 0.84]) with the lower boundary of the RD 95% CI crossing the non-inferiority margin. Additionally, direct MT was associated with a shift toward a higher score on the 90-day mRS (adjusted Common OR 1.59 [95% CI 1.05-2.39]), not confirmed after IPW, and with lower odds of successful recanalization (adjOR 0.38 [95% CI 0.18-0.78]). Rates of 90-day mRS 0-1, sICH, and mortality were similar between groups. In our target trial emulation, direct MT was not non-inferior to IVT&#x2009;+&#x2009;MT treatment beyond 4.5&#x2009;h from symptom onset or at wake-up, with IVT before MT yielding higher successful recanalization rates.

To evaluate the prognostic significance of tumor p16(INK4a) expression in predicting treatment response and survival in patients with locally advanced squamous cell vulvar cancer (LAVC) undergoing chemoradiotherapy (CRT). Retrospective data were collected from patients with stage II-IVB disease managed with definitive or neoadjuvant CRT between January 2016 and March 2024. Clinical response to CRT and survival outcomes according to tumor p16 expression were evaluated. Among 61 patients, 39 (63.9%) had p16-negative (p16-) tumors, 22 (36.1%) had p16-positive (p16+) tumors. p16 positivity was linked to higher complete clinical response (cCR) rates (odds ratio [OR]=9.8; p<0.001) and, after adjusting for tumor size, lymph node status and radiation dose, was the only independent predictor of cCR (OR=7.0; p=0.003). The 3-year progression-free survival (PFS), locoregional control (LRC), and overall survival (OS) rates were 12.6%, 17.3%, and 19.5% for p16- tumors, 60.4% (p<0.001), 80.4% (p<0.001), and 64.9% (p<0.001) for p16+ tumors. Among patients who achieved a cCR, the 3-year PFS, LRC and OS were 14.3%, 14.3%, and 33.3% for p16- tumors, 69.6% (p=0.001), 85.7% (p<0.001), and 80.2% (p=0.008) for p16+ tumors. p16 positivity was independently associated with improved PFS (hazard ratio [HR]=0.15, p<0.001), LRC (HR=0.09, p<0.001), and OS (HR=0.16, p<0.001). Larger tumor size adversely affected all outcomes, while age, lymph node status, and RT dose were not significant predictors. p16(INK4a) expression predicts treatment response, locoregional disease control and survival in LAVC undergoing upfront CRT. These findings highlight the importance of integrating p16 expression into treatment protocols and future clinical trials.

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APOE is the strongest genetic risk factor for late-onset Alzheimer's disease. Despite global efforts to promote resilience, delay cognitive decline, and slow aging, APOE &#x3b5;2, one of the most robust resilience-associated variants, remains relatively underexplored in translational research. Exceptional longevity offers a window into cognitive trajectories. We present clinical, cognitive and neuroimaging data from five APOE &#x3b5;2/&#x3b5;3 siblings aged 94-105. Cognition ranged from normal to mild dementia. MRI showed less atrophy than expected for advanced age, and FDG-PET revealed preserved metabolism. Findings demonstrate APOE &#x3b5;2-associated resilience in the oldest-old and offer insight into mechanisms of exceptional cognitive aging with potential translational relevance.

We assessed the effect of hepatic iron levels on liver apparent diffusion coefficient (ADC) values assessed by magnetic resonance imaging (MRI) and the influence of different b-values on the extent of this association. We prospectively enrolled 110 patients (60 women, 33.05&#x2009;&#xb1;&#x2009;7.86&#x2009;years) with beta-thalassemia. Single-shot echoplanar diffusion-weighted imaging (DWI) with different b values was acquired, and ADC_200 (b-values 0/200&#x2009;s/mm2), ADC_600 (b-values 0/600&#x2009;s/mm2), and ADC_1000 (b-values 0/1000&#x2009;s/mm2) were obtained. Liver T2* values were measured with a gradient-echo multiecho sequence and were converted into liver iron concentration (LIC) values. There was a significant difference among the three different ADC values (p&#x2009;<&#x2009;0.0001). Mean MRI LIC values were 7.99&#x2009;&#xb1;&#x2009;10.09&#x2009;mg/g dw, and 64 (58.2%) patients had liver iron overload (LIC&#x2009;>&#x2009;3&#x2009;mg/g dw). Significant negative correlation was found between MRI LIC values and ADC_200 values (R&#x2009;=&#x2009;-0.284, p&#x2009;=&#x2009;0.003), ADC_600 values (R&#x2009;=&#x2009;-0.645, p&#x2009;<&#x2009;0.00001), and ADC_1000 values (R&#x2009;=&#x2009;-0.842, p&#x2009;<&#x2009;0.0001). MRI LIC was more strongly correlated with both ADC_600 and ADC_1000 than with ADC_200 (p&#x2009;<&#x2009;0.00001 for both comparisons) and with ADC_600 than with ADC_200 (p&#x2009;<&#x2009;0.0001). ADC_200 values were comparable between patients without and with liver iron overload (2.11&#x2009;&#xb1;&#x2009;0.53 vs. 1.87&#x2009;&#xb1;&#x2009;0.89&#x2009;&#xd7;&#x2009;10-3&#x2009;mm2/s, p&#x2009;=&#x2009;0.081), while patients with liver iron overload had significantly decreased ADC_600 values (0.91&#x2009;&#xb1;&#x2009;0.72 vs. 1.52&#x2009;&#xb1;&#x2009;0.49&#x2009;&#xd7;&#x2009;10-3&#x2009;mm2/s, p&#x2009;<&#x2009;0.0001), and ADC_1000 values (0.48&#x2009;&#xb1;&#x2009;0.38 vs. 1.23&#x2009;&#xb1;&#x2009;0.23&#x2009;&#xd7;&#x2009;10-3&#x2009;mm2/s, p&#x2009;<&#x2009;0.0001). In conclusion, the demonstrated inverse correlation between LIC and liver ADC values, accentuated at higher diffusion b-values, has relevant clinical implications, indicating that liver iron overload acts as a confounding factor in quantitative DWI and should be accounted for to avoid misinterpretation of liver ADC measurements in diagnostic and therapeutic workflows.

Osteosarcomas (OS), the most common primary malignant bone tumours, are classified as low-grade (characterised by MDM2 amplification) or high-grade (with complex karyotypes). Accurate diagnosis is essential for treatment and prognosis. This study evaluates pre-analytical variables associated with the success or failure of epigenetic analyses in osteosarcoma samples and proposes a standardised preparation protocol. Retrospective cohort study of adult patients with OS diagnosed at our sarcoma reference centre (CSUR) over the past 20 years. Pre-analytical variables: year of diagnosis, histological subtype, tissue type, site of origin, sample type (core needle biopsy or surgical specimen with or without chemotherapy), decalcification method (none, EDTA, or nitric acid), and FISH availability. Five 5-&#x3bc;m sections were obtained from each paraffin block. DNA methylation profiling was performed using the Infinium MethylationEPIC v2.0 platform (Illumina). Univariate and multivariate analyses were performed to identify failure predictors. A total of 103 samples from 79 patients were analysed: 58 conventional OS, 14 extraskeletal, 24 parosteal, and 7 dedifferentiated OS. Of the 95 formalin-fixed, paraffin-embedded (FFPE) samples, 43 (45.2%) were suitable for epigenetic analysis, whereas all frozen samples were adequate (100%). Decalcification affected success rates, although not significantly: nitric acid was associated with the highest failure rate (68.97%), followed by EDTA (57.14%) and non-decalcified samples (46.15%). FFPE samples are suitable for epigenetic studies, although performance depends on pre-analytical factors. Frozen tissue remains the gold standard. Nitric acid should be avoided. A protocol is proposed that prioritises frozen tissue, documents decalcification methods, excludes strong acids, incorporates quality control measures, and favours samples less than five years old.

Peptic ulcer disease remains one of the leading causes of non-variceal upper gastrointestinal bleeding. Despite advances in endoscopic therapy and pharmacological management, recurrent bleeding continues to represent a major cause of morbidity and mortality. Risk stratification is traditionally based on endoscopic stigmata according to the Forrest classification; however, ulcers with similar endoscopic findings may exhibit markedly different clinical outcomes. Increasing evidence suggests that ulcer-related anatomical factors, including size, location, and depth of penetration, may influence the risk of severe or recurrent hemorrhage, particularly in cases involving adjacent arterial structures. In this conceptual, hypothesis-generating review, we propose a conceptual bi-dimensional framework integrating endoscopic and anatomical determinants of bleeding risk. This approach aims to improve patient stratification by identifying a subgroup at "very-high-risk" of recurrent bleeding, in whom standard endoscopic therapy alone may be insufficient. Although this framework is hypothesis-generating and not yet validated, it may provide a conceptual basis for future studies aimed at improving individualized management strategies, including early imaging assessment and consideration of transarterial embolization in selected high-risk patients.

Fetal MRI has been proved to be a valuable complement to prenatal ultrasound in the study of congenital abnormalities, especially those of the central nervous system. However, its role in the assessment of the fetal abdomen is less known. Fetal abdominal pathology includes congenital abnormalities of the gastrointestinal tract, genitourinary tract, and abdominal wall defects. The aims of this article are to indicate an assessment protocol for the fetal abdomen, determine which patients will benefit from this technique and illustrate with examples the value of prenatal MRI and the role of the radiologist, both in diagnosis and perinatal management of these patients.

Here, we present the case of a 25-year-old patient with G542X and G85E cystic fibrosis mutations who underwent computed tomography examination before and after triple-combination therapy. Clear improvement in sinonasal and lung involvement is visible two years after modulator treatment initiation. To the best of our knowledge, this is the first report about sinonasal improvement demonstrated by computed tomography images in a patient with G542X/G85E mutations.

Cannabis is the most used recreational drug, typically consumed by smoking. Its incomplete combustion produces pollutants similar to tobacco smoke, including carbon monoxide, particulate matter, and polycyclic aromatic hydrocarbons. However, the respiratory effects of cannabis smoke remain incompletely understood. This study aimed to explore and evaluate the impact of chronic cannabis smoking on respiratory health, particularly in individuals without tobacco used. Individuals who had smoked cannabis for at least the past five years or on 100 or more occasions during the previous year were invited for an evaluation of respiratory health utilizing current standard methods: a questionnaire for symptoms (cough, phlegm, wheezing and dyspnea), pre and post-bronchodilator spirometry, IOS, DLCOsb, and a HRCT. Fifty-eight subjects were analyzed, including 20 exclusive cannabis smokers, 29 dual users, and 9 polysubstance users. Overall, 29% reported at least two chronic respiratory symptoms; 43% reported regular or poor general health; 66% had an abnormality in at least one lung-function test, with 57% showing an obstructive pattern; and 47% had at least one abnormality in the HRCT. No statistically significant differences were detected between groups; however, the study may have been underpowered to identify small between-group differences. In this exploratory study chronic cannabis users, either exclusive or in combination with other substances, a high frequency symptoms, functional abnormalities, and tomographic findings have been documented, despite their young age.

Penile pathology encompasses a wide spectrum of conditions. Among the most common lesions are vascular abnormalities (Mondor's disease, thrombosis of the corpus cavernosum, erectile dysfunction and priapism), traumatic injuries (penile fracture, intracavernous and extraalbugineal haematomas), inflammatory and infectious processes (abscess and gangrenous cavernositis), benign lesions (Peyronie's disease and others) and malignant lesions (both primary and metastatic). A radiologist's knowledge of these conditions is fundamental for accurate diagnosis and appropriate treatment, with a significant potential impact on both quality of life and clinical management. The aim of this article is to illustrate the key imaging findings of the main penile pathologies using different imaging modalities and to review the principal differential diagnoses through representative cases.

To investigate demographic, morphologic, and morphometric variables associated with early or subclinical imaging-based osteoarthritic structural changes of temporomandibular joint (TMJ). Cone-beam computed tomography scans of 396 TMJs from 198 asymptomatic individuals (75 males, 123 females) were analyzed. TMJs were classified as normal-appearing, indeterminate for osteoarthritis (OA), or affected by OA based on condyle, and fossa/eminence morphology. Univariate and multivariate logistic regression models assessed the association of 5 patient-level and 20 TMJ-level variables with the indeterminate or affected by OA status, adjusting for confounding. Prevalence rates of the indeterminate and affected by OA statuses were 25.80% and 33.30% at the patient-level and 25.30% and 24.50% at the TMJ-level, respectively. Whereas complete/partial edentulism was the only strong/independent indicator for indeterminate for OA category, strong indicators associated with the affected by OA status included age&#x2009;>&#x2009;38.50 years, complete/partial edentulism, Class II skeletal relationship, horizontal condylar angle&#x2009;&#x2265;&#x2009;24.14 degrees, condylar height&#x2009;&#x2264;&#x2009;16.00&#xa0;mm, sagittal glenoid fossa width&#x2009;>&#x2009;16.95&#xa0;mm, sagittal articular eminence angle&#x2009;&#x2264;&#x2009;45.78 degrees, glenoid fossa roof thickness&#x2009;>&#x2009;1.23&#xa0;mm (coronal) and >&#x2009;1.20&#xa0;mm (sagittal). CBCT imaging provides a reliable framework for identifying both established and early osteoarthritic changes in the TMJ of asymptomatic adults. Indeterminate cases, often marked by flattening or sclerosis, should be regarded as transitional stages that warrant closer monitoring.

Posterior disc displacement (PDD) of the temporomandibular joint (TMJ) is an uncommon condition that remains that remains poorly documented in the literature. This study aimed to characterize the magnetic resonance imaging features of PDD and assess their distribution according to sex, age, and selected imaging variables. In this retrospective study, 1,266 TMJ MRI examinations from a private radiology service were screened. Sixty-two patients with unilateral or bilateral PDD were identified, comprising 91 affected TMJs analyzed individually. MRI scans were reviewed in consensus by two experienced radiologists. The assessment included displacement extent, reduction status, degenerative bone changes, condylar shape or size alterations, TMJ mobility, and the presence and location of joint effusion on T2-weighted sequences. Statistical analysis was performed using the chi-square test and Fisher's exact test. No statistically significant differences were observed in the overall distribution of PDD between sexes, and no associations were found with age, degenerative/morphological condylar alterations, or hypomobility. However, female patients presented a significantly higher frequency of displacement with reduction (p&#x202f;=&#x202f;0.006). Only one TMJ exhibited degenerative changes, and no joint effusion was observed. PDD showed a particular MRI pattern in this sample, especially regarding reduction status in female patients, the low occurrence of degenerative bone changes, and the absence of joint effusion. This MRI-based characterization may support more consistent recognition and reporting of this uncommon finding, although its clinical relevance should be further investigated in studies with standardized symptom correlation.

Purpose To perform a meta-analysis of the head-to-head performance of dark-blood (DB) late gadolinium enhancement (LGE) and bright-blood (BB) LGE for myocardial scar detection. Materials and Methods This systematic review and meta-analysis included studies identified from PubMed, Embase, and the Cochrane Library, from database inception through October 2025, in which both DB LGE and BB LGE were acquired in the same patient sample. In eligible studies, at least one prespecified outcome (per-segment or per-patient LGE detection, papillary enhancement, scar-to-blood contrast-to-noise ratio [CNR], or reader confidence) was reported. Outcomes were pooled as odds ratios (ORs), mean differences (MDs), or standard MDs (SMDs) using a random-effects model, and heterogeneity was assessed with the I2 statistic. Subgroup analyses according to LGE etiology were performed when data permitted. Results Twenty-three studies including 1823 patients were analyzed. DB LGE was associated with higher overall segment-level LGE detection (OR, 1.26 [95% CI: 1.10, 1.44]), overall per-patient LGE detection (OR, 1.19 [95% CI: 1.01, 1.40]), ischemic segment-level detection (OR, 1.31 [95% CI: 1.15, 1.49]), and papillary muscle LGE detection (OR, 2.82 [95% CI: 1.81, 4.42]). DB LGE was also associated with a higher scar-to-blood CNR (MD, 10.48 [95% CI: 5.95, 15.01]) and greater reader confidence in the detection of ischemic LGE (SMD, 0.72 [95% CI: 0.23, 1.20]). Conclusion DB LGE was associated with higher myocardial scar detection and greater scar-to-blood contrast than BB LGE, particularly for ischemic patterns and papillary muscle fibrosis. Keywords: MR Imaging, Cardiac, Heart, Myocardium, Ischemia/Infarction, Technical Aspects, Meta-Analysis, Cardiac Magnetic Resonance, Late Gadolinium Enhancement, Dark Blood, Bright Blood Supplemental material is available for this article. &#xa9; RSNA, 2026.

This review aims to provide a comprehensive overview of the current evidence on the use of MRI-guided SBRT for oligometastases in gynaecological cancers and its potential benefits. Following PRISMA guidelines, we conducted a systematic review to identify studies focusing on MRI-guided SBRT for oligometastatic gynaecological cancer. Inclusion criteria specified English-language studies that reported clinical outcomes and toxicity data. Data extraction included study design, tumour characteristics, type of MRI-Linac utilized, treatment protocols, clinical outcomes, and toxicity profiles. Of the 475 identified articles, three studies met the inclusion criteria, encompassing 45 patients with oligometastatic gynaecological cancers, predominantly ovarian, treated with 0.35-1.5&#xa0;T MRI-Linac SBRT. Doses ranged from 30 to 50&#xa0;Gy over five fractions. Focusing on actuarial outcome, all the patients were alive and maintained local control at 3&#xa0;months from SBRT. The toxicity profile was available in all the studies, reporting only one Grade 3 event (gastro-intestinal), underscoring a favourable safety profile. Despite some technical challenges, such as extended treatment times and limited MRI-Linac availability, MRI-guided SBRT appears to be a promising modality for oligometastatic ovarian cancer, potentially delaying the need for systemic therapy and chemotherapy line change. Larger studies are required to validate these findings and better establish the advantages relative to the use of this innovative approach.